Both glycolate oxidase (GO) and lactate
dehydrogenase A (LDHA)
influence the endogenous synthesis of oxalate and are clinically validated
targets for treatment of primary hyperoxaluria (PH). We investigated
whether dual inhibition of GO and LDHA may provide advantage over
single agents in treating PH. Utilizing a structure-based drug design
(SBDD) approach, we developed a series of novel, potent, dual GO/LDHA
inhibitors. X-ray crystal structures of compound 15 bound
to individual GO and LDHA proteins validated our SBDD strategy. Dual
inhibitor 7 demonstrated an IC50 of 88 nM
for oxalate reduction in an Agxt-knockdown mouse
hepatocyte assay. Limited by poor liver exposure, this series of dual
inhibitors failed to demonstrate significant PD modulation in an in vivo mouse model. This work highlights the challenges
in optimizing in vivo liver exposures for diacid
containing compounds and limited benefit seen with dual GO/LDHA inhibitors
over single agents alone in an in vitro setting.